Registration form


Here you can register online. We ask you to indicate which practice you wish to register. Once your data is processed in our system, you will receive a confirmation email. We strive to send a confirmation within 2 business days. You will not get an automatically generated confirmation immediately. Do you want to register with more than one person? We kindly request that you send a form for every person in your family (including children) separately. At the moment it's not possible to register in practices of dr Cloosterman and dr Hofstee due to a patient stop.



 

Is someone in your family (child or partner) registered in our practice?

 

   
If, yes:
Name
Date of birth
     


New patient


Choose practice
Initials and surname
Date of birth
     
Gender
   
Address
Zip code
Hometown
Phone no.
Mobile no
E-mail
BSN
Passport / ID number
Name health insurance
Polis no.
Name pharmacy
Medical information former doctor  
Name former doctor
address former doctor
Permission  
printen

Spoed (buiten kantoortijden)
De avonden (vanaf 17.00 uur), nachten, weekenden en feestdagen kunt u voor spoedeisende situaties contact opnemen met de Huisartsenposten Amsterdam, tel. 088 003 06 00.

Voor levensbedreigende
situaties belt u altijd 112.
Online afspraak maken
Klik hier om online een afspraak te maken bij een van onze praktijken.
traveldocter
Onze praktijken zijn aangesloten bij de
Travel Doctor.

Meer informatie >>